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Author Topic: When is the time to start meds?  (Read 1631 times)

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Offline LBpozguy

  • Member
  • Posts: 51
When is the time to start meds?
« on: November 25, 2008, 04:27:13 PM »
Hey everyone, I have been doing a lot of reading on here and there seems to be some disagreement as to when you should start meds.  My diagnosis is fairly recent. Sept 08. My first and only trip to my ID doc found that my CD4 was 558 and VL 11000. I do not know the percentage but I will ask the next time I go to see her. She told me that since my numbers were good, that she recommended that I not start meds yet.

After doing some reading on here, it would seem that most agree with her approach. However, there are others that say you should start meds right away.

I have my next ID Dr visit next week on Wednesday and I intend to ask her more about that. But I thought I would put that question up on here as well to see what the thought is here!
Feb 08 neg
Sept 08 - First poz test
Sept 08 CD4 558 (% unk) VL 11000
Dec 08 CD4 480 (29%) VL less than 700
Mar 09 CD4 370  VL 25000
June 09 CD4 425 VL 68000
Aug 09 Started Atripla
Sept 09 CD4 639 VL 100
Nov 09  CD4 716 (35%) VL Undet!!!!!!!!!!!!!
Jan 10 CD4 685 VL UND

Offline klmbia

  • Member
  • Posts: 12
Re: When is the time to start meds?
« Reply #1 on: November 25, 2008, 04:58:38 PM »
I'm going through the same dilemma right now.   My cd4 is 550 and vl higher than yours at 60K.  I am seriously considering beginning treatment now rather than wait mainly due to recent London studies and other data.  There seems to be enough support to begin early in order to slow the progression.  I would also welcome any comments.

ALAN

Offline Rural_oz

  • Member
  • Posts: 47
Re: When is the time to start meds?
« Reply #2 on: November 25, 2008, 05:13:41 PM »
My response to your question is purely personal and not based on any medical evidence, so please take it as such.  I tested poz in 2001, infection sometime in the previous couple of years!  My health remained good, my VL low and CD4 good.  My choice was to wait.  Last test my CD4 got to 130 and my VL shot up from about 6,000 to 35,000.  I still enjoy good health.  However I have chosen to start medication.
I waited because of a fear of the medications.  Had I know about this forum and the information and support available here I may have chosen medication earlier. 
I suggest that you follow the advice given my your HIV practitioners and your heart.
Hugz and good luck to both of you.

Offline Tempeboy

  • Member
  • Posts: 358
  • Like St Francis of Assisi I am wedded to Poverty
Re: When is the time to start meds?
« Reply #3 on: November 26, 2008, 12:13:07 AM »
Hey LB,

There are lots of guidelines of when to start and here is a summary that I found helpful.  There are guidelines related to different health markers as follows.

Hit early hit hard.

Some believe that treating soon after seroconversion works well - in theory - but the research is not very conclusive.  Many people who try this option are not fully prepared for treatment and find the experience quite distressful.

CD4 count

It is generally accepted that if we start treatments when our count is between 350 and 500 we can avoid HIV related health issues that result from lower CD4 counts.  There are large studies recruiting to see if one of these numbers is better as a starting guide but the results wont be known for a few years.  In the meantime somewhere in between is fine.

The 3 times CD4 theory.

There is some evidence that your CD4 count when you start treatment (nadir) has a maximum number that it will reach once treatments have done their majic (setpoint).  Many theorise that you can work this out by tripling your starting number (nadir).  So if you start with 200 you should get up to 600ish - or if you start at 500 you should expect to end up with a CD4 count over 1,000 - fabulous number.  This is not conclusive science but it can be said with confidence that the lower you go the less high you bounce back - I spose this can be said for many things in life!

Viral Load

Most experts agree that 35,000 is a good time to start treatment.  Having a higher viral load than this for a long time is thought to cause damage as a result of stimulating a constant inflammatory response from the immune system.  This is when we might see viral load related health issues such as fatigue, rash, depression, headaches, sleep problems and joint pain.  These usually improve once treatments do their majic.

HIV related health issues.

Even with good numbers some people still experience things like frequent chest infections or recurrence of shingles.  These people sometimes choose to go on treatments earlier than their numbers might suggest in order to stop these issues recurring.  Once treatments do their majic these recurrent health issues often improve greatly if not resolve.

Serodisco - poz/neg - magnetic love.

Sometimes the poz partner in a poz/neg relationship will start medications sooner as one strategy of many to prevent passing on HIV to their negative partner.  Treatments do not stop us passing on HIV to others - but undetectable virus in cum greatly reduces the risk.

Most important - when you are ready.

There is a huge amount of research that tells us that the single best predictor of successful treatment of HIV is the psychological preparedness of the person starting treatment.  When someone knows what they are going to take and when they are ready to start they can prepare for minor side effects in the induction period (first days to weeks of starting).  People then also have time to work out how to fit medication into their day to day lives as well as having opportunities to talk to others in the same situation - reducing anxiety.

Has anyone discussed the Induction Period with you?  Understanding this can often reduce anxiety - the most common side effect of treatment - and sometimes the hardest to treat.

Take care.
Roughly roundabout somewhere in the eighteenth or nineteenth century, Sodomite begat Homosexual out of moral, medical and legal models, bequeathing him Identity, who inbred with Nuclear Family and Industrialism to spawn Homophobia.

Dean Kiley

Offline klmbia

  • Member
  • Posts: 12
Re: When is the time to start meds?
« Reply #4 on: November 26, 2008, 11:41:17 AM »
Thanks OZ and Tempe:  I am Alan (the second response to LB).  You guys have given me a lot to think about and I suppose that I should just bite the bullet and begin.  I do not see any problem with myself ahereing to the dosage schedule.  Because my VL (60,000) is so high, I am scared not to do this eventhough my CD4 is still 550. 

Let me get through Thanksgiving and I'll probably begin next week.  Hey LB...let me know what you've decided.  My doc is suggesting Norvir, Reyataz and Truvada as I am resistant to all NNRTI's.

Thanks again, guys.

ALAN
« Last Edit: November 26, 2008, 11:43:28 AM by klmbia »

Offline LBpozguy

  • Member
  • Posts: 51
Re: When is the time to start meds?
« Reply #5 on: November 26, 2008, 01:12:06 PM »
Hi Oz and Tempe:

Thanks for the info.

Tempe:  You asked me "Has anyone discussed the Induction Period with you? " My answer is no. I have only been to my ID doctor once. At that time, my CD4 count was 558 and VL was 11000. That was from a blood test taken in Sept by my regular MD and I saw her (my ID Dr)  Nov 5th. She took blood while I was at her office and I get those results Wed. Dec 3rd. On Nov 5th, she said that my numbers looked good and that she would like to not put me on meds yet.

I will let you know next week what the new blood test show. Also, she ran some other test to see if I have a drug resistant  HIV and a number of other test that I am not really sure what they were for. But again I will let you know what they were and the results.

My feeling is that I may want to think about starting them soon. I have been having body aches in my upper and lower back, in my shoulders, and I am finding that some days I am getting fatigued easlily. I also have been getting mild head aches. I will let my ID Dr know these things as well.
Feb 08 neg
Sept 08 - First poz test
Sept 08 CD4 558 (% unk) VL 11000
Dec 08 CD4 480 (29%) VL less than 700
Mar 09 CD4 370  VL 25000
June 09 CD4 425 VL 68000
Aug 09 Started Atripla
Sept 09 CD4 639 VL 100
Nov 09  CD4 716 (35%) VL Undet!!!!!!!!!!!!!
Jan 10 CD4 685 VL UND

Offline bufguy

  • Member
  • Posts: 161
Re: When is the time to start meds?
« Reply #6 on: November 26, 2008, 05:18:42 PM »
My doctor started me with a CD4 of 511 and Vl of 47,500. He thought since I was educated, motivated and would stay adherent there was no reason to wait.
I never felt sick, but wanted to do SOMETHING!
Its been 6 months and I have no regrets. 100% adherent on once a day Atripla.
undetectable and feeling fine.
5/29/08 confirmed HIV+
6/23/08 Vl 47500  CD4 511/29% CD8 .60
start atripla
8/1/08 Vl 130  CD4 667/31% CD8 .70
9/18/08 Vl un  CD4 not tested
12/19/08 Vl un CD4 723/32% CD8 .80
4/3/09 Vl un CD4 615/36% CD8  .98
8/7/09 vl un CD4 689/35% CD8 .9
12/11/09 vl un CD4 712/38% CD8 .89
4/9/10 vl un CD4 796/39% CD8 1.0
8/20/10 vl un CD4 787/38% CD8 1.0
4/6/10 vl un CD4 865/35% CD8 .9
8/16/10 vl un CD4 924/37% CD8 1.0
12/23/10 vl un CD4 1006/35% CD8 .9
5/2/10 vl un CD4 1040/39% CD8 .9
8/7/13 vl un CD4 840/39% CD8 .9

Seadickrun

  • Guest
Re: When is the time to start meds?
« Reply #7 on: November 27, 2008, 07:05:41 AM »
When is the time to start meds?  When your doctor advises you to do so:))  I started with a vl of 285,000 and CD4 of 283 and a good dose of anemia.  I would not advise anyone to wait that long.


Offline LBpozguy

  • Member
  • Posts: 51
Re: When is the time to start meds?
« Reply #8 on: December 10, 2008, 07:11:13 PM »
WOW, I am so excited. I had my second visit with my ID Dr and when she came in the room, she walked in saying "She had GREAT news"  My CD4 count was just under 500, my CD4 % was 29% and my VL dropped from 11000 to under 700. The VL was too low to detect the DNA of the HIV.  This without any meds. I asked her what would have dropped the VL like that and she said that it could be any number of things but that most likely it is my body fighting! I am so excited!!  Woo Hoo!!
Feb 08 neg
Sept 08 - First poz test
Sept 08 CD4 558 (% unk) VL 11000
Dec 08 CD4 480 (29%) VL less than 700
Mar 09 CD4 370  VL 25000
June 09 CD4 425 VL 68000
Aug 09 Started Atripla
Sept 09 CD4 639 VL 100
Nov 09  CD4 716 (35%) VL Undet!!!!!!!!!!!!!
Jan 10 CD4 685 VL UND

 


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